Annexure-B APPLICATION FORM Employment Notice No. GMA/MR/Rectt /Cultural/S&G Quota: 2014-15 Post Applied for (Para 1 of Notification) 1. G.P. Rs.1900/- Or G.P. Rs.1800/District Candidate to please indicate one G.P.
2 3
Please paste your recent passport size colour photo, not more than three months old, without cap & sunglasses.
Name of candidate(in Block letters): Father’s Name
Date of Birth MM
DD
4
5
YYYY
Age as on 01.01.2015 Year
Month
Days
Community (Tick) 6
SC
ST
OBC
UR
7. Address for Communication: 8 9 10 11
PIN 12
Nearest Railway Station (in English only for issue of free Railway Pass for SC/ST Candidate)
13
Visible marks of Identification (Moles./Cut marks etc on your body
Nationality Religion Sex (M/F) Marital Status (Married/Single)
i.
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ii.
a. Education Qualification Details
Qualifications Matriculate /10th Class
University/Board
Year of passing
% of Marks/Grade
Higher Secondary/ XII Degree & Above
b. Scouting & Guiding Achievements Details of the Certificate obtained by the Candidate
Yes / No
Year
Certificate Enclosed
i) President’s Scout/Guide/Ranger/Rover OR Himalayan Wood Badge Holder OR A PreHWB trained Scout Leader/Advanced Trained Guide Leader/ Captain. ii) Active member of a Scouts Organisation for at least 3(Three) years in the recent past (Certificate of active membership duly signed by DOC, Scouts/Guides and countersigned by District Commissioner, Scouts/Guides of respective Scouts Districts). iii) Attended at least one event at National level and one or two events at State level OR have a good record of participation in Scouts/Guides activities at Unit/District level. 15. Declaration by the candidates(copy the passage in the box below in your running hand writing of the candidate) I do hereby declare that all the particulars given above by me in regards to my Age, Educational Qualifications, Scouting & Guiding Achievements, etc. are true and to the best of my knowledge. I am aware that in the event of any information furnished by me is found false/incorrect at any stage, even after my selection/posting, my candidature will be rejected summarily and I am also liable for criminal action.
